Comparing self-reported medication adherence measures with hair antiretroviral concentration among people living with HIV in Guangxi, China

Abstract

Background: Antiretroviral adherence is essential to HIV treatment efficacy. Various self-reported measures are commonly used for assessing antiretroviral adherence. Limited data are available regarding the validity of those selfreported measures in comparison with long-term objective biomarkers of adherence measures such as hair measures. Methods: Self-reported adherence (frequency, percentage, and visual analog scale [VAS]) and hair tenofovir concentration were evaluated at a single time point from 268 people living with HIV in China. The responses to each of three self-reported measures were converted into percentage and then dichotomized as "optimal" (100%) vs. "suboptimal" (less than 100%) adherence. Two composite adherence scores (CAS) were created from the three self-reported measures: (1) an overall adherence was the average percentage of the three self-reported measures; (2) responses were termed optimal adherence if participants reporting optimal adherence in all three self-reported measures, while were termed suboptimal adherence. Hair tenofovir concentration was also dichotomized as "optimal" (above the limit of quantitation, 36 pg/mg) vs. "suboptimal" adherence (blow 36 pg/mg). Spearman correlation, kappa statistics, and logistic regression analysis were used to calculate the correlations, agreements, and predictions of self-reported measures with hair measure, respectively. Results: Overall adherence, but any of the three self-reported adherence, was correlated with hair tenofovir concentration (r = 0.13, p < 0.05). Self-reported optimal adherence in VAS and CAS measures were agreed with and predicted optimal adherence assessed by hair measure (Kappa = 0.107, adjusted OR = 1.88, 95% CI 1.03-3.45; Kappa = 0.109, adjusted OR = 1.80, 95% CI 1.02-3.18; all p < 0.05, respectively). Conclusion: VAS may be a good individual self-reported measure for antiretroviral adherence, and CAS may be a good composite self-reported measure for antiretroviral adherence.

Association of Self-Reported Medication Adherence with Potentially Inappropriate Medications in Elderly Patients: A Cross-Sectional Pilot Study

“…The VAS tool was presented to each patient with a continuous line ranging from 0% to 100%, and he or she was asked to mark the line at his or her best guess about self-medication adherence. A VAS score of 100% was defined as full medication adherence, as described previously [52,53].…”

“…Although medication non-adherence is an important drug-related issue in all populations, it is particularly problematic for elderly patients, who often experience a variety of medical conditions and use more medications compared to other patients [36]. The medication adherence of patients is assessed by evaluating medical/dispensing records and pharmacy claims data, such as the Medication Possession Ratio [37,38] and the Proportion of Days Covered [39][40][41][42]; using electronic monitoring devices [43,44]; using patient self-reports [45], such as the Morisky Medication Adherence Scale [46,47] and the visual analogue scale (VAS) [48][49][50][51][52][53]. The VAS is a tool that helps clinicians or pharmacists assess the medication adherence of patients in routine clinical practice.…”

“…Selinger et al (2019) assessed four adherence measurement tools, including VAS, Medication Adherence Report Scale, Medication Possession Ratio, and blood level of thiopurine metabolites in inflammatory bowel disease (IBD) patients and found that all four methods significantly associated with each other [54]. In some of the previous studies, a cut-off value of 80% was used to divide medication adherence into good or poor [48][49][50][51], while other studies used a cut-off value of 100% [52,53]. The VAS is quick, inexpensive, and easily applicable during medical visits and has been validated against pharmacy refills for patients with chronic diseases [48][49][50][51][52][53].…”

“…In some of the previous studies, a cut-off value of 80% was used to divide medication adherence into good or poor [48][49][50][51], while other studies used a cut-off value of 100% [52,53]. The VAS is quick, inexpensive, and easily applicable during medical visits and has been validated against pharmacy refills for patients with chronic diseases [48][49][50][51][52][53]. Because we believe that VAS is more advantageous than other tools from this point of view, we have incorporated it into our clinical practice.…”

Adherence Measurements among HIV-positive Adolescents on ARVs in Cameroon: Comparison between Self-report and the Medication Possession Ratio

“…Adherence can also be measured directly by measuring metabolites including detection of drugs in plasma. However, there is no gold standard of adherence measurement [11] although self-report is the most used tool for adherence measurement [12].…”